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Medicine (Baltimore) ; 100(4): e23920, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530192


BACKGROUND: Lamaze breathing has been widely used as a breathing training method. Nursing intervention including postural nursing, delivery ball, doula nursing, massage and psychological nursing is usually provided by nurses during labor. A number of clinical studies have investigated the effect of Lamaze breathing training combined with nursing intervention on maternal pain relief and outcomes improvement. But there were some scholars who were against it. METHODS: Randomized controlled trials from January 2000 to November 2019 in PubMed, Cochrance Library, Medline, Web of Science, Embase, Chinese Academic Journals, Chinese Biomedical Literature Database, VIP Database, Wanfang Database were searched. Two researchers independently screened the literature according to the criteria. After extracting the data, the researchers used Cochrane system to evaluate the literature quality. Statistical analyses were performed by using Comprehensive Meta Analysis V2 software. RESULTS: Twenty-two randomized controlled trials conducted on 7035 primiparas were eligible. The results revealed that Lamaze breathing training combined with nursing intervention increased the rate of natural delivery (relative risk [RR] = 2.97, 95% confidence interval [CI] [2.48, 3.56]), shortened the length of labor (-2.604, 95% CI [-3.120, -2.087]), alleviated labor pain (RR = 0.194, 95% CI [0.115, 0.325]) and reduced postpartum bleeding (-2.966, 95% CI [-4.056, -1.877]). CONCLUSIONS: Lamaze breathing training combined with nursing intervention was effective for ameliorating the process and outcomes of childbirth in primiparae and deserves to be promoted and applied in clinical practice.

Trabajo de Parto/fisiología , Parto Normal/métodos , Parto Normal/enfermería , Parto/fisiología , Femenino , Humanos , Dolor de Parto/terapia , Paridad , Hemorragia Posparto/prevención & control , Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Tiempo
BMJ Case Rep ; 14(1)2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33514616


A 31-year-old G3P2002 with history of two prior caesarean sections presented with influenza-like illness, requiring intubation secondary to acute respiratory distress syndrome. Investigations revealed intrauterine fetal demise at 30-week gestation.She soon deteriorated with sepsis and multiple organs impacted. Risks of the gravid uterus impairing cardiopulmonary function appeared greater than risks of delivery, including that of uterine rupture. Vaginal birth after caesarean was achieved with misoprostol and critical care status rapidly improved.Current guidelines for management of fetal demise in patients with prior hysterotomies are mixed: although the American College of Obstetricians and Gynecologists recommends standard obstetric protocols rather than misoprostol administration for labour augmentation, there is limited published data citing severe maternal morbidity associated with misoprostol use. This case report argues misoprostol-augmented induction of labour can be a reasonable option in a medically complex patient with fetal demise and prior hysterotomies.

Muerte Fetal/etiología , Trabajo de Parto Inducido/métodos , Trabajo de Parto/efectos de los fármacos , Misoprostol/administración & dosificación , Oxitócicos/administración & dosificación , Administración Intravaginal , Adulto , Parto Obstétrico/normas , Femenino , Humanos , Histerotomía/efectos adversos , Intubación Intratraqueal/métodos , Misoprostol/farmacología , Insuficiencia Multiorgánica/etiología , Oxitócicos/farmacología , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Tercer Trimestre del Embarazo , /terapia , Resultado del Tratamiento , Rotura Uterina/prevención & control
BMC Pregnancy Childbirth ; 21(1): 82, 2021 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-33494712


BACKGROUND: The intrapartum period is a time of high mortality risk for newborns and mothers. Numerous interventions exist to minimize risk during this period. Data on intervention coverage are needed for health system improvement. Maternal report of intrapartum interventions through surveys is the primary source of coverage data, but they may be invalid or unreliable. METHODS: We assessed the reliability of maternal report of delivery and immediate newborn care for a sample of home and health facility births in Sarlahi, Nepal. Mothers were visited as soon as possible following delivery (< 72 h) and asked to report circumstances of labor and delivery. A subset was revisited 1-24 months after delivery and asked to recall interventions received using standard household survey questions. We assessed the reliability of each indicator by comparing what mothers reported immediately after delivery against what they reported at the follow-up survey. We assessed potential variation in reliability of maternal report by characteristics of the mother, birth event, or intervention prevalence. RESULTS: One thousand five hundred two mother/child pairs were included in the reliability study, with approximately half of births occurring at home. A higher proportion of women who delivered in facilities reported "don't know" when asked to recall specific interventions both initially and at follow-up. Most indicators had high observed percent agreement, but kappa values were below 0.4, indicating agreement was primarily due to chance. Only "received any injection during delivery" demonstrated high reliability among all births (kappa: 0.737). The reliability of maternal report was typically lower among women who delivered at a facility. There was no difference in reliability based on time since birth of the follow-up interview. We observed over-reporting of interventions at follow-up that were more common in the population and under-reporting of less common interventions. CONCLUSIONS: This study reinforces previous findings that mothers are unable to report reliably on many interventions within the peripartum period. Household surveys which rely on maternal report, therefore, may not be an appropriate method for collecting data on coverage of many interventions during the peripartum period. This is particularly true among facility births, where many interventions may occur without the mother's full knowledge.

Trabajo de Parto/psicología , Recuerdo Mental , Madres/psicología , Periodo Periparto/psicología , Autoinforme , Adulto , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Visita Domiciliaria , Humanos , Nepal , Embarazo , Apoyo Social , Adulto Joven
MCN Am J Matern Child Nurs ; 46(1): 30-35, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33048860


For new families giving birth in a hospital setting, the COVID-19 pandemic has presented numerous challenges to their birth, breastfeeding, and postpartum experiences. We present experiences of three first-time, healthy mothers and their babies, as they gave birth in the hospital and were breastfeeding during the start of the pandemic in Philadelphia, PA. Each case is framed in the mother's prenatal goals, infant feeding intentions, birth, breastfeeding, and postpartum experiences. Shared concerns and experiences among the three participants are described in five key areas: 1) Recommendations changing every day, 2) Guilt, concern, and stress, 3) In-person versus telehealth visits, 4) Missing time with family and friends, and 5) Silver linings. Through these mothers' experiences, nurses and other health care providers can learn from their perceptions and events and proactively work to ensure we provide sound anticipatory guidance, enhance our communication, and improve provision of evidence-based lactation care and support.

Lactancia Materna/psicología , Atención Posnatal/psicología , Periodo Posparto/psicología , Adulto , Ansiedad/psicología , Femenino , Humanos , Recién Nacido , Trabajo de Parto , Embarazo , Autoimagen
Enferm. clín. (Ed. impr.) ; 30(6): 411-418, nov.-dic. 2020. tab
Artículo en Español | IBECS | ID: ibc-197671


OBJETIVO: Describir las percepciones y deseos sobre el parto en un grupo de gestantes a término de Zamora. MÉTODO: Estudio cualitativo de carácter fenomenológico. Participantes y ámbito de estudio: embarazadas de 37-38 semanas, centros de salud Zamora Sur y Santa Elena (Zamora). Recogida de datos: entrevistas semiestructuradas, hasta llegar a saturación de datos (16 entrevistas). Análisis de datos: análisis de contenido temático. RESULTADOS: Los sentimientos maternos variaron desde la alegría hasta el miedo o el estrés. Las entrevistadas manifestaron no sentirse capaces de soportar el dolor del parto. Las necesidades que sintieron como más importantes fueron contar con apoyo y acompañamiento en el parto (sobre todo de su pareja) y recibir buen trato de los sanitarios. CONCLUSIONES: La importancia y la repercusión del parto para la mujer no solo atiende al ámbito biológico, sino en gran medida también al mental, al emocional y al social. En él intervienen múltiples factores que lo condicionan: los sentimientos maternos, su capacidad de afrontar el dolor del parto, sus necesidades, sus cambios realizados, el apoyo con el que cuentan y los profesionales sanitarios que atienden a la mujer

OBJECTIVE: To describe perceptions and wishes regarding childbirth in a group of full-term pregnant women in Zamora. METHOD: Qualitative study of phenomenological character. Participants and scope of study: pregnant women (37-38 weeks), Zamora Sur and Santa Elena health centres (Zamora, Spain). Data collection: semi-structured interviews, until data saturation (16 interviews). Data analysis: analysis of thematic content. RESULTS: The maternal feelings varied from joy to fear or stress. The interviewees said they did not feel capable of enduring the pain of childbirth. The needs that they felt most important were having support and accompaniment during delivery (especially of their partner) and receiving good treatment from the healthcare workers. CONCLUSIONS: The importance and repercussion of childbirth for women are not only biological, but also largely mental, emotional and social. It is conditioned by multiple factors: maternal feelings, their ability to deal with the pain of childbirth, their needs, the changes they have made, the support they have and the health professionals who care for them

Humanos , Femenino , Embarazo , Nacimiento a Término , Percepción , Trabajo de Parto/psicología , Servicio de Acompañamiento de Pacientes/psicología , Enfermeras Obstetrices/estadística & datos numéricos , Enfermeras Obstetrices/psicología , Parto Obstétrico/métodos , Parto Obstétrico/enfermería , Muestreo , Dolor de Parto/enfermería , Dolor de Parto/psicología
Medicine (Baltimore) ; 99(52): e22237, 2020 Dec 24.
Artículo en Inglés | MEDLINE | ID: mdl-33350719


PURPOSE: To evaluate the predictive accuracy of transvaginal ultrasound (TVU) cervical length (CL) for spontaneous onset of labor in singleton gestation enrolled at term by a meta-analysis. MATERIALS AND METHODS: This protocol established in this study has been reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Web of Science, PubMed, EMBASE, and the Cochrane Library were searched for all clinical trials assessing the accuracy of TVU CL in prediction of spontaneous onset of labor in singleton gestations with vertex presentation who were enrolled at term until August 15, 2020. We will use a combination of Medical Subject Heading and free-text terms with various synonyms to search based on the eligibility criteria. Two investigators independently reviewed the included studies and extracted relevant data. The 95% confidence intervals (CIs) of was used as effect estimate. I-square (I2) test, substantial heterogeneity, sensitivity analysis, and publication bias assessment will be performed accordingly. Stata 15.0 and Review Manger 5.3 are used for meta-analysis and systematic review. RESULTS: The results will be published in a peer-reviewed journal. CONCLUSION: The results of this review will be widely disseminated through peer-reviewed publications and conference presentations. This evidence may also assess the accuracy of TVU CL in prediction of spontaneous onset of labor in singleton gestations with vertex presentation. REGISTRATION NUMBER: INPLASY202080065.

Medición de Longitud Cervical , Trabajo de Parto , Metaanálisis como Asunto , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Medición de Longitud Cervical/métodos , Femenino , Humanos , Valor Predictivo de las Pruebas , Embarazo , Vagina
Rev. enferm. UERJ ; 28: e45901, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1129836


Objetivo: conhecer a percepção das mulheres sobre a assistência no trabalho de parto, parto e nascimento realizada por enfermeiras obstétricas em um hospital público do Sul do Brasil. Método: estudo qualitativo, descritivo-exploratório, desenvolvido em fevereiro de 2019. Participaram 24 mulheres no pós-parto mediato, internadas no Alojamento Conjunto. Os dados foram coletados através de entrevista semiestruturada e posteriormente analisados conforme proposta operativa de Minayo. O projeto foi submetido e aprovado pelo Comitê de Ética. Resultados: ressaltou-se a importância da atuação da enfermeira obstétrica no cuidado humanizado e respeitoso durante o trabalho de parto, destacando seu papel no estímulo ao uso dos métodos não farmacológicos de alívio da dor durante o trabalho de parto, além da oferta de apoio emocional. Conclusão: a atuação da enfermeira obstétrica, na percepção das mulheres, qualifica a assistência prestada, sendo avaliada de forma positiva pelas participantes do estudo.

Objective: to learn how women at a public hospital in southern Brazil perceive the care given by obstetric nurses during labor, delivery and birth. Method: twenty-four postpartum women participated in this exploratory, qualitative, descriptive study from January to February 2019. Data were collected through individual, semi-structured interviews, and subsequently analyzed according to Minayo's operative proposal. The project was approved by the research ethics committee. Results: obstetric nurses were found to play an important role in respectful, humanized care during labor, particularly in encouraging the use of nonpharmacological methods of pain relief during labor, in addition to offering emotional support. Conclusion: the obstetric nurses' work, as perceived by the women, enhances the quality of the care provided, and was evaluated favorably by the study participants.

Objetivo: conocer cómo las mujeres de un hospital público en el sur de Brasil perciben la atención brindada por enfermeras obstétricas durante el trabajo de parto, el parto y el parto. Método: de enero a febrero de 2019 participaron veinticuatro puérperas de este estudio exploratorio, cualitativo y descriptivo. Los datos fueron recolectados a través de entrevistas individuales semiestructuradas y posteriormente analizados de acuerdo con la propuesta operativa de Minayo. El proyecto fue aprobado por el comité de ética en investigación. Resultados:se encontró que las enfermeras obstétricas desempeñan un papel importante en el cuidado humanizado y respetuoso durante el trabajo de parto, particularmente en el fomento del uso de métodos no farmacológicos de alivio del dolor durante el trabajo de parto, además de ofrecer apoyo emocional. Conclusión: el trabajo de las enfermeras obstétricas, percibido por las mujeres, mejora la calidad de la atención brindada y fue evaluado favorablemente por las participantes del estudio.

Humanos , Femenino , Embarazo , Adulto , Adulto Joven , Trabajo de Parto , Humanización de la Atención , Enfermeras Obstetrices , Percepción , Brasil , Satisfacción del Paciente , Investigación Cualitativa , Periodo Posparto , Maternidades
Rev. enferm. UERJ ; 28: e52496, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1145870


Objetivo: apresentar modelo representativo da interação social de puérperas com procedimentos invasivos durante o trabalho de parto, a partir dos significados por elas atribuídos. Método: estudo interpretativo, qualitativo, realizada em maternidade pública do Rio de Janeiro. Foram entrevistadas 12 puérperas, de 18 a 45 anos, divididas em 3 grupos amostrais. Dados analisados segundo o Interacionismo Simbólico e a Grounded Theory. Resultados: procedimentos invasivos significam tudo que foge ao curso natural do parto ou viole. Entrando na situação, as mulheres sentem-se desconfortáveis com situações fisiológicas do parto. Confiando no profissional, submetem-se a procedimentos considerando-os necessários ao nascimento do bebê. Conclusão: o modelo representativo aponta que as mulheres se submetem a procedimentos invasivos sem considerá-los invasivos. É necessário criar estratégias que permitam à mulher compreender e tomar decisões sobre seu próprio corpo, bem como estimular a atuação de enfermeiras obstétricas para o cuidado à mulher com base na não invasão.

Objective: to present a representative model of puerperal women's social interaction with invasive childbirth procedures, based on the meanings they attribute to them. Method: this interpretative, qualitative study was conducted at a public maternity hospital in Rio de Janeiro by interview of 12 puerperal women in three sample groups. Data were analyzed in accordance with Symbolic interactionism and Grounded Theory. Results: an invasive procedure is anything that lies outside or violates the natural course of childbirth. Women in labor feel uncomfortable with the physiological situations of childbirth. Trusting in the care professional, they submit to procedures that they consider necessary to their baby's birth. Conclusion: the representative model shows that women submit to invasive procedures, not considering them invasive. Strategies must be developed to permit women to understand and decide on their own bodies, and to encourage obstetric nurses to provide women's care based on non-invasive procedures.

Objetivo: presentar un modelo representativo de la interacción social de las puérperas con los procedimientos invasivos de parto, a partir de los significados que les atribuyen. Método: este estudio interpretativo, cualitativo, se realizó en una maternidad pública de Río de Janeiro mediante entrevista a 12 puérperas en tres grupos de muestra. Los datos se analizaron de acuerdo con el interaccionismo simbólico y la teoría fundamentada. Resultados: un procedimiento invasivo es todo aquello que se encuentra fuera o viola el curso natural del parto. Las mujeres en trabajo de parto se sienten incómodas con las situaciones fisiológicas del parto. Confiando en el profesional asistencial, se someten a los procedimientos que consideran necesarios para el nacimiento de su bebé. Conclusión: el modelo representativo muestra que las mujeres se someten a procedimientos invasivos, no considerándolos invasivos. Se deben desarrollar estrategias para permitir que las mujeres comprendan y decidan sobre su propio cuerpo, y para alentar a las enfermeras obstétricas a brindar atención a las mujeres con base en procedimientos no invasivos.

Humanos , Femenino , Embarazo , Adolescente , Adulto , Persona de Mediana Edad , Adulto Joven , Relaciones Profesional-Paciente , Parto , Mujeres Embarazadas , Medicalización , Maternidades , Brasil , Trabajo de Parto , Investigación Cualitativa , Periodo Posparto , Interaccionismo Simbólico , Hospitales Públicos
Artículo en Inglés | MEDLINE | ID: mdl-33322662


The labor experience and satisfaction with childbirth are affected by the care provided (external factors) and individual variables (internal factors). In this paper, we present a descriptive analysis that aims to indicate the strongest correlates of birth experience among a wide range of indicators. The study is a prospective, cross-sectional, self-report survey. It includes the experiences of women giving birth in public and private hospitals in Poland. The two main variables were birth experience and satisfaction with care. The analysis consists of three parts: data pre-processing and initial analysis, explorative investigation, and regression analysis. Among the 15 variables with the highest predictive value regarding birth experience were being informed by the medical personnel, communication, and birth environment. The most significant variables among 15 variables, with the highest predictive value regarding care, were those concerning support, information, and respectful care. The strongest predictor for both, birth experience and satisfaction with care, is the sense of information, with logit coefficients of 0.745 and 1.143, respectively, for birth experience and satisfaction (0.367 and 0.346 for standardized OLS coefficient). The findings demonstrate that by using explanatory variables, one can predict a woman's description of her satisfaction with perinatal care received in the hospital. On the other hand, they do not have such a significant and robust influence on the birth experience examined by the variables. For both the birth experience and satisfaction with care, the sense of being informed is the highest predictor.

Trabajo de Parto , Satisfacción Personal , Niño , Estudios Transversales , Femenino , Humanos , Recién Nacido , Parto , Satisfacción del Paciente , Polonia , Embarazo , Estudios Prospectivos , Encuestas y Cuestionarios
J Womens Health (Larchmt) ; 29(11): 1361-1371, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33196330


After its identification as a human pathogen in 2019, the novel coronavirus, SARS-CoV-2, has spread rapidly around the world. Health care workers worldwide have had the task of preparing and responding to the pandemic with little evolving data or guidelines. Regarding the protocols for our labor and delivery unit, we focused on applying the four pillars of biomedical ethics-beneficence, nonmaleficence, autonomy, and justice-while considering the women, their fetuses, their significant others and support persons, health care professionals and auxiliary staff, and society as a whole. We also considered the downstream effect of our decisions in labor and delivery on other disciplines of medicine, including pediatrics, anesthesiology, and critical care. This article focuses on how these prima facie principles helped guide our recommendations in this unprecedented time.

Bioética , Infecciones por Coronavirus/prevención & control , Personal de Salud/psicología , Neumonía Viral/prevención & control , Complicaciones Infecciosas del Embarazo/prevención & control , Complicaciones Infecciosas del Embarazo/virología , Betacoronavirus , Coronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Femenino , Humanos , Trabajo de Parto , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Embarazo
Zhonghua Fu Chan Ke Za Zhi ; 55(10): 673-678, 2020 Oct 25.
Artículo en Chino | MEDLINE | ID: mdl-33120478


Objective: To study the correlation between the duration of labor and postpartum hemorrhage. Methods: The delivery data of singleton first-term pregnant women who delivered vaginally at Beijing Obstetrics and Gynecology Hospital from January 1, 2017 to December 31, 2017 were collected, 3 104 cases met inclusion criteria. According to the duration of the first labor (t), they were divided into two groups: t≥8 hours was the observation group, t<8 hours was the control group. In order to ensure the baseline characteristics of the subjects in the two groups were balanced, propensity score matching (PSM) was adopted, with matching ratio 1∶1. Then the observation group was divided into four subgroups: group 8-12 h, group 12-16 h, group 16-20 h, group ≥20 h. According to the presence or absence of labor intervention (oxytocin use, artificial rupture of membranes, labor analgesia), the observation group and control group were divided into non-labor intervention observation group, non-labor intervention control group, labor intervention observation group, and labor intervention control group. The case data of 3 104 subjects were analyzed and the duration of labor and atonic postpartum hemorrhage rate of each subgroup were compared with the control group. Results: The duration of the second stage of labor and the first+second stages of labor in the observation group (median:0.8, 13.3 hours) and its subgroups were both longer than those in the control group (median:0.6, 5.1 hours), with statistically significant differences (all P<0.01). The rate of atonic postpartum hemorrhage in the observation group, group 16-20 h and group ≥20 h were higher than that in the control group [8.0%(124/1 552), 14.3%(41/287), 14.1%(12/85), 4.6%(72/1 552)], with significant statistical differences (all P<0.01). The duration of the second stage of labor and the first+second stages of labor in the observation group were both longer than those in the control group, regardless of the presence or absence of labor intervention, with statistically significant differences (all P<0.01). In both the observation group and the control group, the duration of the first stage of labor, the second stage of labor, and the first+second stages of labor with labor intervention were longer than those of the non-labor intervention, with significant statistical differences (all P<0.01). The rate of atonic postpartum hemorrhage in the observation group with labor intervention [8.7%(110/1 263)] was higher than that in the observation group without labor intervention [4.8%(14/289)], with a statistical difference (P<0.05). Conclusions: With the increase of the duration of the first stage of labor, the rate of atonic postpartum hemorrhage increases. The first stage of labor is closely related to the second stage of labor, and to a certain extent the duration of the second stage of labor increases with the length of the first stage of labor. With the increase of the duration of the first stage of labor, the rate of labor intervention and atonic postpartum hemorrhage also increase, which could serve as a clinical warning that excessive labor intervention may indicate a higher incidence of atonic postpartum hemorrhage.

Parto Obstétrico , Trabajo de Parto , Hemorragia Posparto/epidemiología , Complicaciones del Embarazo/epidemiología , Adulto , Femenino , Humanos , Oxitocina , Hemorragia Posparto/terapia , Embarazo , Complicaciones del Embarazo/etiología , Factores de Riesgo , Factores de Tiempo , Adulto Joven
Obstet Gynecol ; 136(5): 1036-1039, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33030860


The population of women within carceral systems is growing rapidly. A portion of these individuals are pregnant and will deliver while incarcerated. Although shackling laws for pregnant persons have improved, incarcerated patients are forced to labor without the support of anyone but a carceral officer and their medical staff. We believe access to continuous labor support is critical for all pregnant persons. Carceral systems and their affiliated hospitals have the opportunity to change policies to reflect that continuous labor support is a basic human right and should be permitted for incarcerated pregnant persons in labor, either through a doula program or a selected person of choice.

Parto Obstétrico/ética , Trabajo de Parto/psicología , Derechos del Paciente/legislación & jurisprudencia , Atención Perinatal/ética , Prisioneros/psicología , Entorno del Parto , Parto Obstétrico/legislación & jurisprudencia , Femenino , Humanos , Atención Perinatal/legislación & jurisprudencia , Embarazo , Prisioneros/legislación & jurisprudencia
Niger J Clin Pract ; 23(10): 1456-1461, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33047706


Background: Birth preparedness and complication readiness (BPCR) is a strategy with specific interventions to reduce pregnancy related morbidity and mortality. Aim: The study assessed the predictors of optimal birth preparedness and complication readiness among parturient in a tertiary health institution in Nigeria. Subject and Methods: This descriptive cross-sectional study was conducted among parturient at the labor and post-natal wards of University of Nigeria Teaching Hospital Enugu over a 6 months period. Demographic information and predictors of BPCR were analyzed by descriptive statistics and logistic regression respectively with P value of < 0.05 considered statistically significant. Results: Of the 420 parturient, 330 (78.6%) and 90 (21.4%) were booked and unbooked respectively. Majority (74.2%) of the booked and about half of the unbooked parturient were knowledgeable about BPCR. Most (92.4%) of the booked parturient were optimally birth prepared at delivery as against 22.2% of the unbooked. Higher parity (adj OR = 3.79; 95% CI = 1.46-9.82, P = 0.01), tertiary educational level (adj OR = 2.98; 95% CI = 1.23-7.20, P = 0.02), regular antenatal visit (adj OR = 2.68; 95% CI = 1.06-6.76, P = 0.04), information received on birth preparedness before delivery (adj OR = 0.21; 95% CI = 0.07-0.61, P = <0.01), and booked status (adj OR = 0.02; 95% CI = 0.01-0.05, P = <0.001) where significant predictors of optimal BPCR. Conclusion: Encouraging female education, regular antenatal visits, and participation in health talk is advocated to improve BPCR and ultimately reduce maternal and perinatal mortality/morbidity among women in southeast Nigeria.

Parto Obstétrico/psicología , Conocimientos, Actitudes y Práctica en Salud , Trabajo de Parto/psicología , Complicaciones del Trabajo de Parto/psicología , Parto/psicología , Complicaciones del Embarazo/psicología , Mujeres Embarazadas/psicología , Atención Prenatal/métodos , Adulto , Estudios Transversales , Femenino , Hospitales de Enseñanza , Humanos , Modelos Logísticos , Nigeria , Paridad , Mortalidad Perinatal , Embarazo , Adulto Joven
J Pregnancy ; 2020: 4985693, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32953176


Cervical assessment on the Bishop scale prior to induction of labor (IOL) is one of the strongest prognostic criteria in relation to the success of the procedure. The commonly used preinduction methods are mainly aimed at reducing the percentage of cesarean sections. Our study has analyzed obstetric results of patients who had unripe cervix (Bishop score <7) before IOL and used preinduction (Foley catheter or misoprostol vaginal insert releasing 7 mcg of misoprostol per hour for 24 hours) with obstetric results of patients in whom, due to favourable cervix, only a low-dose infusion of oxytocin was used. We reviewed the medical records of 1010 single pregnancies in whom IOL was performed. We divided the patients into two groups: group A (where preinduction was used) and group B (Bishop score ≥7 points) where preinduction was not used. Patients in group A were more likely to complete the delivery by caesarean section (OR = 4.58, 95% CI 3.22-6.51), and more likely to have events that were indications for operative delivery: unreassuring fetal heart rate trace (OR = 3.29, 95% CI 2.07-5.23) and arrested labor or failed induction (OR = 3.4, 95% CI 2.06-5.62). The groups did not differ in the percentage of vacuum extraction, postpartum haemorrhage, and meconium stained amniotic fluid. In group B, more infants were born with umbilical cord blood pH <7.1 (1.38% vs. 0%), both groups included no deliveries of newborns with Apgar score ≤3 points, the groups did not differ in terms of the percentage of newborns with Apgar score between 4 and 7 at birth (OR = 0.66, 95% CI 0.29-1.49). The immature cervix and the need to use labor preinduction is a risk factor for caesarean section. The necessity of preinduction does not impair neonatological results.

Cuello del Útero/fisiología , Trabajo de Parto Inducido/efectos adversos , Trabajo de Parto Inducido/métodos , Trabajo de Parto , Adulto , Cesárea/estadística & datos numéricos , Femenino , Humanos , Oxitocina/administración & dosificación , Embarazo , Resultado del Embarazo , Pronóstico , Estudios Retrospectivos , Factores de Riesgo
J Pregnancy ; 2020: 8395142, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32953178


Background: Episiotomy is the most common obstetric procedure, performed when the clinical circumstances place the patient at a high risk of high-degree laceration. However, episiotomy should be done with judicious indication to lower perineal laceration with fewer complications. Despite its adverse effects, the magnitude of episiotomy is increasing due to different factors. Therefore, this study is aimed at determining the recent magnitude of episiotomy and at identifying associated factors among women who gave delivery in Arba Minch General Hospital, Southern Ethiopia. Methods: An institution-based cross-sectional study was conducted from December 15, 2018, to January 30, 2019. A systematic random sampling technique was used to select study participants. A semistructured questionnaire was used to collect data. This was supplemented with a review of the labor and delivery records. Binary and multivariable logistic regression analyses were performed to identify factors associated with the magnitude of episiotomy. P value ≤ 0.05 was used to determine the level of statistically significant variables. Results: The magnitude of episiotomy was found to be 272 (68.0%) with 95%CI = 64.0-72.5. Women who attended secondary education [AOR = 10.24, 95%CI = 2.81-37.34], women who attended college and above [AOR = 4.61, 95%CI = 1.27-16.71], birth weight ≥ 3000 g [AOR = 4.84, 95%CI = 2.66-8.82], primipara [AOR = 4.13, 95%CI = 2.40-7.12], being housewife occupants [AOR = 3.43, 95%CI = 1.20-9.98], married women [AOR = 2.86, 95%CI = 1.40-5.84], and body mass index < 25 kg/m2 [AOR = 2.85, 95%CI = 1.50-5.44] were independent variables found to have significant association with episiotomy. Conclusion: The magnitude of episiotomy was 68.0% which is higher than the recommended practice by WHO (10%). The study participants' occupational status, marital status, educational status, parity, birth weight, and BMI were significantly associated with the magnitude of episiotomy in the study area. Therefore, to reduce the rate of episiotomy, it is better to have periodic training for birth attendants regarding the indication of episiotomy.

Episiotomía/estadística & datos numéricos , Hospitales Generales/estadística & datos numéricos , Trabajo de Parto , Laceraciones/prevención & control , Madres/estadística & datos numéricos , Adolescente , Adulto , Peso al Nacer , Índice de Masa Corporal , Estudios Transversales , Escolaridad , Episiotomía/efectos adversos , Etiopía/epidemiología , Femenino , Humanos , Ocupaciones , Paridad , Embarazo , Riesgo , Esposos , Encuestas y Cuestionarios , Adulto Joven
Artículo en Inglés | MEDLINE | ID: mdl-32748884


The satisfaction of women with the birth experience has implications for the health and wellness of the women themselves and also of their newborn baby. The objectives of this study were to determine the factor structure of the Women's Views of Birth Labor Satisfaction Questionnaire (WOMBLSQ4) questionnaire on satisfaction with the attention received during birth delivery in Spanish women and to compare the level of satisfaction of pregnant women during the birth process with that in other studies that validated this instrument. A cross-sectional study using a self-completed questionnaire of 385 Spanish-speaking puerperal women who gave birth in the Public University Hospitals of Granada (Spain) was conducted. An exploratory factor analysis of the WOMBLSQ4 questionnaire was performed to identify the best fit model. Those items that showed commonalities higher than 0.50 were kept in the questionnaire. Using the principal components method, nine factors with eigenvalues greater than one were extracted after merging pain-related factors into a single item. These factors explain 90% of the global variance, indicating the high internal consistency of the full scale. In the model resulting from the WOMBLSQ4 questionnaire, its nine dimensions measure the levels of satisfaction of puerperal women with childbirth care. Average scores somewhat higher than those of the original questionnaire and close to those achieved in the study carried out in Madrid (Spain) were obtained. In clinical practice, this scale may be relevant for measuring the levels of satisfaction during childbirth of Spanish-speaking women.

Encuestas de Atención de la Salud/normas , Satisfacción del Paciente , Satisfacción Personal , Atención Prenatal/normas , Encuestas y Cuestionarios/normas , Estudios Transversales , Femenino , Encuestas de Atención de la Salud/métodos , Humanos , Recién Nacido , Trabajo de Parto , Parto , Embarazo , Reproducibilidad de los Resultados , España
Malawi Med J ; 32(1): 13-18, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32733654


Background: This paper reports on part of a larger study, the aim of which was to develop an intervention to collaboratively develop innovative strategies to promote effective collaborative practices among midwives and medical professionals working in intrapartum care unit. Collaborative practice is a critical marker for success in improving quality of maternity care. To date, there has been limited exploration of collaborative practices between midwives and medical professionals working in intrapartum care from the African perspective. Aim: This paper reports findings of the discovery phase of appreciative inquiry (AI) set out to understand the perspectives of midwives and medical professionals on collaborative practices at Queen Elizabeth Central Hospital labour and delivery ward in Malawi. Methods: The study used an exploratory qualitative approach framed in an Appreciative Inquiry theoretical perspective. Appreciative Inquiry consists of four phases :(discovery, dream, design and destiny).The discovery phase consisted of 16 in-depth interviews and 2 focus group discussions among purposively selected midwives (4 nurse midwives, 2 midwifery unit matrons) and medical professionals (2 obstetricians, 4 registrars, 2 intern doctors, 2 clinical officers) working in the labour ward. All interviews and discussions were audiotaped and transcribed verbatim. Data were analysed using thematic analysis. Results: Five dominant themes emerged: collaborative breakdown, benefits of collaboration, the importance of positive and respectful attitude, barriers to effective collaborative practices and strategies to improve collaborative practice. Conclusion/Recommendations: Aligning the perspectives of the members of the two disciplines is significant to effective implementation of collaborative intrapartum care. Participants demonstrated that there is increased parallel working of midwives and doctors at QECH. This is not professionally healthy. Therefore, putting together the viewpoints of the professions to create a mutually agreeable professional framework of collaborative intrapartum practice is significant. Additionally, there is an obvious need to address the professional concerns of both disciplines.

Conducta Cooperativa , Relaciones Interprofesionales , Servicios de Salud Materna/organización & administración , Partería , Enfermeras Obstetrices/psicología , Médicos/psicología , Adulto , Actitud del Personal de Salud , Femenino , Hospitales Universitarios , Humanos , Entrevistas como Asunto , Trabajo de Parto , Malaui , Servicio de Ginecología y Obstetricia en Hospital , Embarazo , Investigación Cualitativa
PLoS One ; 15(8): e0236982, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32745099


BACKGROUND: Continuous intrapartum fetal monitoring is challenging and its clinical benefits are debated. The project evaluated whether short-term-variation (STV) and other computerised fetal heart rate (FHR) parameters (baseline FHR, long-term-variation, accelerations and decelerations) predicted acidaemia at birth. The aims of the study were to assess the changes in FHR pattern during labour and determine the feasibility of undertaking a definitive trial by reporting the practicalities of using the monitoring device, participant recruitment, data collection and staff training. METHODS: 200 high-risk women carrying a term singleton, non-anomalous fetus, requiring continuous FHR monitoring in labour were consented to participate from the Jessop Wing maternity unit, Sheffield, UK. The trans-abdominal fetal ECG monitor was placed as per clinical protocol. During the monitoring session, clinicians were blinded to the computerised FHR parameters. We analysed the last hour of the FHR and its ability to predict umbilical arterial blood pH <7.20 using receiver operator characteristics (ROC) curves. RESULTS: Of 200 women, 137 cases were excluded as either the monitor did not work from the onset of labour (n = 30), clinical staff did not return or used the monitor on another patient (n = 37), umbilical cord blood not obtained (n = 25), FHR data not recorded within an hour of birth (n = 34) and other reasons (n = 11). In 63 cases included in the final analysis, the computer-derived FHR parameters did not show significant correlation with umbilical artery cord pH <7.20. Labour was associated with a significant increase in short and long term variation of FHR and number of deceleration (P<0.001). However, baseline FHR decreased significantly before delivery (P<0.001). CONCLUSIONS: The project encountered a number of challenges, with learning points crucial to informing the design of a large study to evaluate the potential place of intrapartum computerised FHR parameters, using abdominal fetal ECG monitor before its clinical utility and more widespread adoption can be ascertained.

Electroencefalografía/instrumentación , Monitoreo Fetal/métodos , Frecuencia Cardíaca Fetal/fisiología , Acidosis/fisiopatología , Adulto , Cardiotocografía , Electrocardiografía , Estudios de Factibilidad , Femenino , Sangre Fetal , Enfermedades Fetales/fisiopatología , Feto/fisiopatología , Humanos , Concentración de Iones de Hidrógeno , Trabajo de Parto , Embarazo